Guideline

Guidelines on the management of latent tuberculosis infection

Year of Publication

2014

Issuing Institution

WHO

Links

WHO IRIS,WHO IRIS,Google Scholar

Recommendations

9 included recommendations

Systematic testing and treatment of latent tuberculosis infection (LTBI) should be performed in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor (TNF) treatment, patients receiving dialysis, patients preparing for organ or haematologic transplantation, and patients with silicosis. Either interferon-gamma release assays (IGRA) or Mantoux tuberculin skin test (TST) should be used to test for latent tuberculosis infection (LTBI).

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

Systematic testing and treatment of latent tuberculosis infection (LTBI) should be considered for prisoners, health workers, immigrants from high TB burden countries, homeless persons and illicit drug users. Either IGRA or TST should be used to test for latent tuberculosis infection (LTBI).

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Low

Systematic testing for latent tuberculosis infection (LTBI) is not recommended in people with diabetes, people with harmful alcohol use, tobacco smokers, and underweight people unless they are already included in the above recommendations

Status

Retired

Recommended against

Conditional

Certainty of evidence

Very low

For resource-limited countries and other middle-income countries that do not belong to the above category (according to existing and valid WHO guidelines) (5,6): • People living with HIV and children below 5 years of age who are household or close contacts of people with TB and who, after an appropriate clinical evaluation, are found not to have active TB but have latent tuberculosis infection (LTBI) should be treated

Status

Retired

Recommended in favor

Strong

Certainty of evidence

High

Individuals should be asked about symptoms of TB before being tested for latent tuberculosis infection (LTBI). Chest radiography can be done if efforts are intended also for active TB case finding. Individuals with TB symptoms or any radiological abnormality should be investigated further for active TB and other conditions.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

Individuals should be asked about symptoms of TB before being tested for latent tuberculosis infection (LTBI). Chest radiography can be done if efforts are intended also for active TB case finding. Individuals with TB symptoms or any radiological abnormality should be investigated further for active TB and other conditions.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

Either TST or IGRA can be used to test for latent tuberculosis infection (LTBI) in high-income and upper middle-income countries with estimated TB incidence less than 100 per 100 000.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

IGRA should not replace TST in low-income and other middle-income countries.

Status

Retired

Recommended against

Strong

Certainty of evidence

Very low

The following treatment options are recommended for the treatment of latent tuberculosis infection (LTBI): 6-month isoniazid, or 9-month isoniazid, or 3-month regimen of weekly rifapentine plus isoniazid, or 3–4 months isoniazid plus rifampicin, or 3–4 months rifampicin alone

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Moderate